| Mary Black Family Medicine-dorman | |
|
5229 Highway 221 Roebuck SC 29376-3305 | |
| (864) 576-8193 | |
| Not Available |
| Full Name | Mary Black Family Medicine-dorman |
|---|---|
| Speciality | Family Medicine |
| Location | 5229 Highway 221, Roebuck, South Carolina |
| Authorized Official Name and Position | Debbie Brewer (DIRECTOR PROVIDER ENROLLMENT) |
| Authorized Official Contact | 6154657626 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Black Family Medicine-dorman Po Box 277827 Atlanta GA 30384-7827 Ph: (864) 253-8063 | Mary Black Family Medicine-dorman 5229 Highway 221 Roebuck SC 29376-3305 Ph: (864) 576-8193 |
| NPI Number | 1134364615 |
|---|---|
| Provider Enumeration Date | 12/11/2008 |
| Last Update Date | 12/11/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134364615 | NPI | - | NPPES |
| GP4773 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Mary Black Family Medicine Dorman Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5229 Highway 221, Roebuck, SC 29376 Phone: 864-576-8193 | |
Medical Group Of The Carolinas - Family Medicine - Dorman Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5229 Highway 221, Roebuck, SC 29376 Phone: 864-576-8193 Fax: 864-576-8952 | |
Roebuck Family Practice Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2001 E Blackstock Rd, Suite 400, Roebuck, SC 29376 Phone: 864-587-0200 Fax: 864-587-0300 |